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Osteomalacia Q&As

Published by Bupa's health information team, November 2008.

Answers to questions about osteomalacia

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

Why are people aged 65 or over more at risk of developing osteomalacia?

People aged 65 years or over are more likely to develop osteomalacia, often referred to as age-related osteomalacia. This is mainly because they get less calcium and vitamin D from their diet and sunlight than they used to.

Explanation

As we get older our metabolism changes and we become less mobile. Both of these changes can put people aged 65 and over at risk of developing age-related osteomalacia.

A diet lacking in vitamin D is a major cause of osteomalacia. As we get older, we are less able to absorb all the nutrients we need from food. Also, elderly people who live alone may be less able to look after themselves resulting in a poor diet, lacking in vitamins and nutrients.

Often getting older means becoming less mobile. This can result in being housebound or moving into a care home. Most of the vitamin D you need comes from sunshine. If you are unable to get outside in the sunlight, you may develop a deficiency leading to osteomalacia.

If you are over 65, you should take daily vitamin D and calcium supplements. It has been recommended that the amount of vitamin D you take should be between 10 and 20 micrograms. If you are over 80, your GP may be able to prescribe these for you.

In some care homes vitamin D and calcium supplements are given to elderly residents to help prevent falls and fractures. With osteomalacia, as bones soften and weaken, you may become more frail and less stable, making it more likely that you will fall and break a bone. Giving calcium and vitamin D supplements can reduce the risk of falls and fractures. SIGN (Scottish Intercollegiate Guidelines Network) recommend that all elderly people in care homes should be given these supplements.

However, recent research has suggested that there are some risks to older people associated with taking supplements. Research has shown that post-menopausal women who take vitamin D and calcium supplements are at risk of developing kidney stones. If you have any concerns, speak to your GP.

Further information

Sources

  • Primary vitamin D deficiency in adults. Drug and Therapeutics Bulletin, 2006. 44: 25-29.
  • Simon, C, Everitt, H, and Kendrick, T, Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007
  • Prevention and Management of Hip Fracture in Older People. The Scottish Intercollegiate Guidelines Network (SIGN), 2002. www.sign.ac.uk
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Why are people of Asian, African Caribbean or Middle Eastern descent more likely to get osteomalacia?

Osteomalacia is more common in people of Asian, African Caribbean or Middle Eastern origin for two reasons, their exposure to sunlight and their diet.

Explanation

Osteomalacia is usually caused by a lack of vitamin D. People of Asian, African Caribbean or Middle Eastern origin are more at risk of developing the condition mainly because of the limited amount of vitamin D their bodies are able to make in the UK's less sunny climate. Diet is also a factor, although much less so than sun exposure.

The darker your skin, the more sunlight you need to get enough vitamin D - a lot more than people with light skin. The sun in the UK is not strong enough to give you the amount of vitamin D you need. This is especially so during the winter months when the sun is much weaker. People who have immigrated to the UK from warmer climates are at a much higher risk of developing osteomalacia than people who are native to the UK.

Also, women from some cultures completely cover themselves up for religious reasons, for example by wearing a burka. This prevents any sunlight from getting to their skin, putting them at risk of vitamin D deficiency.

Another cause of osteomalacia is a diet lacking in vitamin D and calcium. If you eat a poor diet, lacking in nutrients, or restrictive diet, such as vegetarian or vegan, you may miss out on these vital vitamins and minerals. Also, cultural differences in our diets can mean that certain nutrients are missed. For example people who regularly eat chapatti are at risk of not getting enough calcium as it's thought that chapatti flour prevents calcium being absorbed in the stomach.

A diet that is low in vitamin D and calcium coupled with limited exposure to the sun puts you at a greater risk of developing osteomalacia. However, there are several steps you can take to try to prevent it.

  • Make sure you get plenty of calcium and vitamin D in your diet. Good sources of calcium include dairy products (eg milk, yoghurt and cheese), bread made with fortified flour and dried fruits. Vitamin D can be found in oily fish, eggs, margarine (fortified with vitamin D) and breakfast cereals (fortified with vitamin D).
  • Most of the vitamin D you need comes from the sun, so spend some time outside in the sunshine. But take care not to burn.
  • Take vitamin D supplements. A supplement containing 10 micrograms of vitamin D is usually recommended for most people in the UK. However, if you are of Asian, African Caribbean or Middle Eastern origin, you should take a higher dose of 20 micrograms. You can buy vitamin D supplements from you local pharmacy. Always read the patient information leaflet that comes with your supplements.

Further information

Sources

  • Primary vitamin D deficiency in adults. Drug and Therapeutics Bulletin, 2006. 44: 25-29.
  • Primary vitamin D deficiency in children. Drug and Therapeutics Bulletin, 2006. 44: 12-19.
  • Allgrove, J, Is nutritional rickets returning? Archives of Disease in Childhood, 2004. 89: 699-701.
  • Osteomalacia (Soft Bones). Arthritis Research Campaign. www.arc.org.uk, accessed 27 March 2008
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Can vitamin D or calcium supplements affect other medicines that I'm already taking?

Yes, certain medicines, such as those for heart conditions or epilepsy, may be affected by taking vitamin D and calcium supplements. It's important to talk to your GP or pharmacist before taking vitamin or mineral supplements.

Explanation

Vitamin D and calcium supplements are extremely effective in treating and preventing osteomalacia. However, if you are already taking medicines for other conditions, you need to be careful about how they affect vitamin and mineral supplements.

Medicines for epilepsy such as phenytoin (eg Epanutin) and barbiturates (eg Sodium Amytal), and some anti-inflammatories (corticosteroids) can lessen the effects of taking vitamin D supplements. If you are taking vitamin D supplements as treatment for your osteomalacia or to help prevent it, this means they will be less effective.

The effects of some heart medicines such as digoxin (eg Lanoxin) can be made stronger by taking vitamin D and calcium supplements. Your GP will need to monitor you carefully if you are taking these medicines with vitamin D supplements. He or she will check your heart rate and the calcium levels in your blood on a regular basis.

Vitamin and mineral supplements can also affect your body's ability to absorb some medicines, including:

  • levothyroxine which is used to treat an underactive thyroid
  • bisphosphonates which are used to treat osteoporosis and some cancers (eg Fosamax)
  • sodium fluoride which is used to prevent tooth decay (eg FlouriGard mouthwash)
  • some antibiotics - quinolone (eg Ciproxin) and tetracycline (eg Deteclo)
  • iron supplements (eg Feospan)

If you are taking any medicines, it's important to talk to your GP or pharmacist before taking vitamin D or calcium supplements.

Sources

  • Primary vitamin D deficiency in adults. Drug and Therapeutics Bulletin, 2006. 44: 25-29.
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Related topics

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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Mr Roger Tillman, Royal Orthopaedic Hospital, Birmingham, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: November 2008.

 

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